PHEC Secondary Survey, Packaging and Prolonged Field Care

Question 1

What do you do for a Secondary Survey

Answer 1

Check Cat Hem and Vitals (RR, Pulse, AVPU, PEARL)
Head to Toe
Check Cat Hem and Vitals (RR, Pulse, AVPU, PEARL)

Question 2

Secondary Survey Zone 1

Answer 2

Head and Neck
Stiff-neck collar if any C-Spine concern
Dress wounds
Recheck <C>ABCD
Full feel of the head, scalp and neck
Look for bleeding from the eyes, nose or ears
Palpate bony points for tenderness and irregularities</C>

Question 3

Secondary Survey Zone 2

Answer 3

Chest
Rise N Fall
Check Russell chest seal
Dress wounds
Recheck <C>ABCD</C>

Question 4

Secondary Survey Zone 3

Answer 4

Abdomen and Pelvis
Dress wounds – saline dressing for any exposed abdominal contents
Check any binders / Stabilisation of pelvic fractures
All 9 regions and as far round back as possible
Recheck <C>ABCD</C>

Question 5

Secondary Survey Zone 4

Answer 5

Upper and Lower Limbs
Dress wounds
Stabilize fractures
Recheck <C>ABCD</C>

Question 6

Packaging Considerations

Answer 6

Safety
Climatic
Tactical situation
Care may be need to be interrupted at any point to extract the casualty or to return fire if the situation changes.
The helicopter opportunity may arrive unannounced, for example a re-tasked helicopter.
Be ready to move with the casualty as soon as possible.

Question 7

Packaging Immobilisation Types

Answer 7

Triangular bandages
Fracture straps and bandages
Slings
Splints
Cervical collars
Long board

Question 8

Packaging Checks

Answer 8

Check monitoring equipment
Placement of 3 lead ECG
Utilise as per manufacturers instructions
Check equipment in working order
Check you have correct equipment
Check vital signs

Check all lines are secure (IV/IO)
Check IV/ IO are secure before evacuation:
IV: Adhesive tape, SAM splint, Crepe bandage
IO: Use kit supplied

Question 9

Packaging Documentation

Answer 9

Obtain vital signs and record on field documentation
Log all casualty information
Include personal details
History of complaint (brief consultation)
Allergy
Medication
Query diagnosis
Care plan
ATMIST

Question 10

Packaging Splinting Aims and Methods

Answer 10

Splinting Aims: Support, Immobilize, Elevate, Relieve pain
Splinting Methods: Improvised, Purpose made

Question 11

Packaging Splinting Kit

Answer 11

SAM Splint
Kendrick Traction Splint / Device
Pelvic Splint

Question 12

Kendrick Traction Splint Indications

Answer 12

Indicated for closed midshaft femur fractures, Contraindicated for any lower leg or knee injuries. Consideration is any pelvic injuries / pelvic binder may not use a KTD

Question 13

Kendrick Traction Splint Checks

Answer 13

Check 3 Ps
Penis
Pain
Pedal Pulse

Question 14

Pelvic Splint - When to use

Answer 14

MOI
Blast
Fall from height
RTC
Double leg amputation
Visible injury / incontinence / pain / bruising / splayed feet / leg length discrepancy

Question 15

State the Importance of Continuous Care

Answer 15

The cycle of continuous care is important because it allows us to look after personnel’s medical conditions, assist with normal bodily function and provide emotional support.

Question 16

Cycle of Prolonged Casualty Care

Answer 16

Monitoring – Reassess – Documenting – Nursing Care – Back to Monitoring etc, Evacuate ASAP

Question 17

Prolonged Casualty Care Monitoring

Answer 17

To detect minor problems before the casualty’s condition deteriorates.
NEWS Scores
MO will usually indicate how often observations should be checked.
But if on your own:
Monitor every 15 minutes for first two hours
If stable, increase to:
Every 30 minutes for the next four hours

Question 18

Prolonged Casualty Care Reassess

Answer 18

Trauma situation, continue going over CABCD
Reassess Triage Priority
Establishing if any changes or deterioration

Question 19

Prolonged Casualty Care Documentation

Answer 19

Allows any trends to be reviewed
FMED 826 - Field Medical Card

Question 20

Prolonged Casualty Care - Principles

Answer 20

Prepare for PCC, Monitor and Resus, Pain Relief and Meds, Wound Care and Infection Control, Patient Care, Documentation, Prepare for Evacuation, Kit Management, Team Management

Question 21

Pre-Evacuation Checks

Answer 21

H: Head to toe examination (Zone 1-4 as per secondary survey)
I: Infection (type, wound care, dressings, clotting)
T: Tubes (functioning, secure?, hygiene)
M: Medication (relevant and sufficient for transfer, analgesia, sedatives, antibiotics, antiemetics, antipyretics)
A: Analgesia Non drug and drug measures, 3Ps
N: Nutrition & hydration (input & output)
N: Notes & Documentation

Question 22

Evacuation and in Transit Care Considerations

Answer 22

Have you enough medical equipment
Have you enough toilet facilities
Are there sufficient blankets
Is there enough space for the casualty’s equipment
Ensure there are enough rations and water for you and the casualty

Question 23

Consent

Answer 23

Obtain consent – Best practice
Adults assumed to be competent in making decisions
Can withdraw at any time
Parental responsibility with young people
Patients require sufficient information
Consent can be written, oral or non verbal
Competent adults can refuse treatment
No-one can give consent on behalf of incompetent adult

Question 24

Utilisation of PPE

Answer 24

Min Risk - No PPE
Low Risk - Gloves and plastic Apron
High Risk - Gloves, Apron / Fluid repellent gown, if risk of splashing eye protection and face mask
Identified Infection Control Risk - PPE dependent on transmission risk, seek IPC advice